Bleeding Diathesis – Dr Kopolovich

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  • alvarezzy

    don’t forget amicar =) love this drug on pt’s with either etoh cirrhosis (low platelets, high INR) or pt’s on coumadin s/p dental extraction now with post-op bleeding..
    allows me to avoid giving blood products on the slow oozers (after trying your lido/epi, ice rinse (voodoo?), direct pressure with gauze…)

    from uptodate: Aminocaproic acid: Drug information
    Dosing: Adult
    Acute bleeding: Oral, I.V.: Loading dose: 4-5 g during the first hour, followed by 1 g/hour for 8 hours (or 1.25 g/hour using oral solution) or until bleeding controlled (maximum daily dose: 30 g)

    Control of bleeding with severe thrombocytopenia (unlabeled use) (Bartholomew, 1989; Gardner, 1980):
    Initial: I.V.: 100 mg/kg (maximum dose: 5 g) over 30-60 minutes
    Maintenance: Oral, I.V.: 1-4 g every 4-8 hours or 1 g/hour (maximum daily dose: 24 g)

    ***Control of oral bleeding in congenital and acquired coagulation disorder (unlabeled use): Oral: 50-60 mg/kg every 4 hours (Mannucci, 1998)

    Prevention of dental procedure bleeding in patients on oral anticoagulant therapy (unlabeled use): Oral rinse: Hold 4 g/10 mL in mouth for 2 minutes then spit out. Repeat every 6 hours for 2 days after procedure (Souto, 1996). Concentration and frequency may vary by institution and product availability.

    and the price?

    Tablets (Aminocaproic Acid Oral)
    500 mg (100): $312.71

    or $22 bucks for 70kg patient.

    for those who want the mechanism: Binds competitively to plasminogen; blocking the binding of plasminogen to fibrin and the subsequent conversion to plasmin, resulting in inhibition of fibrin degradation (fibrinolysis).

    ***dosing used at our institution

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